With the ultimate goal of developing an accident and emergency (A&E) department HIV testing program in Belize City, Belize, we sought input from key stakeholders on program components and potential facilitators and barriers to HIV testing in emergency care. We conducted semistructured interviews among 4 key stakeholder groups at Karl Heusner Memorial Hospital Authority (KHMHA) in Belize City: (1) 20 A&E patients, (2) 5 A&E physicians, (3) 5 A&E nurses, and (4) 5 KHMHA administrators. We performed a qualitative content analysis of the interview transcripts and isolated important themes. Major themes included: (1) Patient selection: patients preferred to test all A&E patients. All other stakeholder groups preferred testing specific patient groups. (2) Training: Specific training should be completed for staff. (3) Confidentiality: integral for testing. (4) Facilitators and barriers: facilitators included respectful relationships, privacy, resources, coordination, and education. Barriers included stigmatization, patient willingness, inadequate resources, privacy, and testing biases.
Results: The objectives were evaluated for appropriateness for 3 previously defined provider groups: (1) out-of-hospital providers, nurses, (2) medical officers, senior nurses, and (3) residents, specialists, consultants. There were 7 voting participants in the modified Delphi process. All Tier 3 objectives (79) met consensus. One objective from Tier 2 was revised under consensus, and one objective was added with consensus agreement to create a list of 42 objectives. Five objectives in Tier 1 did not initially achieve consensus, 4 of which required revisions, for a final list of 30 objectives. Conclusion: A group consensus process resulted in the development of a list of 161 objectives for a pediatric emergency medicine curriculum for multiple levels of practitioners in African settings. These objectives will guide development of the AFEM pediatric emergency medicine curriculum, which will advance pediatric emergency care competency across Africa.
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